Association of fluid balance trajectories with clinical outcomes in patients with septic shock: A prospective multicenter cohort study

Mei-Ping Wang; Li Jiang; Bo Zhu; Bin Du; Wen Li; Yan He; Xiu-Ming Xi

doi:10.1186/s40779-021-00328-1

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Association of fluid balance trajectories with clinical outcomes in patients with septic shock: A prospective multicenter cohort study

RESEARCH | Updated：2023-02-28

- Association of fluid balance trajectories with clinical outcomes in patients with septic shock: A prospective multicenter cohort study
- Military Medical Research Vol. 8, Issue 3, Pages: 395-404(2021)
- Affiliations：
  
  1.Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10, Xitoutiao, You’anmen, Beijing, Fengtai District, China
  2.Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, No. 20, Street Fuxingmenwai, Beijing, Xicheng District, China
  3.Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
  4.Medical Intensive Care Unit, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
- Author bio：
  
  * yanhe1220@126.com;
  xixiuming2937@163.com
- Funds：
- DOI：10.1186/s40779-021-00328-1
  CLC：
- Published：2021-09
- Accepted：
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Wang et al.: Association of fluid balance trajectories with clinical outcomes in patients with septic shock: A prospective multicenter cohort study. Mil Med Res, 2021, 8: 40.
DOI：

Wang et al.: Association of fluid balance trajectories with clinical outcomes in patients with septic shock: A prospective multicenter cohort study. Mil Med Res, 2021, 8: 40. DOI： 10.1186/s40779-021-00328-1.

摘要

Abstract

Background:

Septic shock has a high incidence and mortality rate in Intensive Care Units (ICUs). Earlier intravenous fluid resuscitation can significantly improve outcomes in septic patients but easily leads to fluid overload (FO)

which is associated with poor clinical outcomes. A single point value of fluid cannot provide enough fluid information. The aim of this study was to investigate the impact of fluid balance (FB) latent trajectories on clinical outcomes in septic patients.

Methods:

Patients were diagnosed with septic shock during the first 48 h

and sequential fluid data for the first 3 days of ICU admission were included. A group-based trajectory model (GBTM) which is designed to identify groups of individuals following similar developmental trajectories was used to identify latent subgroups of individuals following a similar progression of FB. The primary outcomes were hospital mortality

organ dysfunction

major adverse kidney events (MAKE) and severe respiratory adverse events (SRAE). We used multivariable Cox or logistic regression analysis to assess the association between FB trajectories and clinical outcomes.

Results:

Nine hundred eighty-six patients met the inclusion criteria and were assigned to GBTM analysis

and three latent FB trajectories were detected. 64 (6.5%)

841 (85.3%)

and 81 (8.2%) patients were identified to have decreased

low

and high FB

respectively. Compared with low FB

high FB was associated with increased hospital mortality [hazard ratio (

)=1.63

95%CI 1.22–2.17]

organ dysfunction [odds ratio (

)=2.18

95%CI 1.22–3.42]

MAKE (

=1.80

95%CI 1.04–2.63) and SRAE (

=2.33

95%CI 1.46–3.71)

and decreasing FB was significantly associated with decreased MAKE (

=0.46

95%CI 0.29–0.79) after adjustment for potential covariates.

Conclusion:

Latent subgroups of septic patients followed a similar FB progression. These latent fluid trajectories were associated with clinical outcomes. The decreasing FB trajectory was associated with a decreased risk of hospital mortality and MAKE.

关键词

Keywords

references

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